BMC Anesthesiology最新文献

{"title":"Comparison of the anesthetic effects of remimazolam tosilate and remimazolam besylate in daytime hysteroscopic surgery.","authors":"Huan Zhang, Min Fu, Fangli Yue, Yaxin Wei, Xinyuan Shi, Shiyu Yu, Fanceng Ji","doi":"10.1186/s12871-024-02773-6","DOIUrl":"10.1186/s12871-024-02773-6","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study is to observe whether there is a difference in the anesthetic effect of remimazolam tosilate and remimazolam besylate in daytime hysteroscopic surgery, so as to provide reference for clinical application.</p><p><strong>Methods: </strong>Fifty patients, aged 18-65 years, ASA I-II, scheduled for hysteroscopy under total intravenous anesthesia were selected. The patients were randomly divided into two groups (n = 25): remimazolam tosilate group (group T) and remimazolam besylate group ( group R). The main observation index was the induction dose of remimazolam; secondary observation indicators were sleep time, anesthesia maintenance time, recovery time, induction maintenance dose of alfentanil, maintenance dose of remimazolam, and incidence of adverse events during anesthesia ( hypertension, hypotension, bradycardia, tachycardia).</p><p><strong>Results: </strong>There was no significant difference in anesthesia induction dose, recovery time, sleep time, anesthesia maintenance time, and incidence of adverse events during anesthesia ( body movement, cough, hypertension, hypotension, bradycardia, tachycardia) between the two groups (P > 0.05).</p><p><strong>Conclusion: </strong>There was no significant difference in the anesthetic effect of remimazolam tosilate and remimazolam besylate in daytime hysteroscopic surgery.</p><p><strong>Clinical trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2400081688.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the efficacy of difficult airway alerts in electronic medical records: a quality improvement study.","authors":"Wen-Shen Lee, Luke R Fletcher, Shervin Tosif, Timothy Makar, Jon M Graham","doi":"10.1186/s12871-024-02747-8","DOIUrl":"10.1186/s12871-024-02747-8","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of difficult airway alerts in a major tertiary centre.</p><p><strong>Objective: </strong>To investigate the completeness, utility and efficacy of difficult airway alerts and their impact on future airway management episodes.</p><p><strong>Design, data sources and methods: </strong>Patients who had a \"difficult airway\" entry on electronic medical records (EMR) from 2011 to 2021 were included. Each alert was analyzed by a team of anesthetists with expertise in difficult airway management for its quality, appropriateness, and impact on future airway management episodes. Alert quality was defined as to whether the content of the alert contained pertinent information for emergent airway management. Alert appropriateness was defined as to whether the experts would be unhappy to perform a rapid sequence induction and intubation, if required, following review of all available documentation.</p><p><strong>Results: </strong>141 patients were included for this study, with a mean age of 58.6 +/- 15.3 years. Ninety-three (66%) alerts were created by medical staff, of which 52 were recorded by consultant anesthetists. 117 alerts (83%) were deemed to be appropriate by the airway expert team, but only 40 alerts (28%) were found to have sufficient quality to be helpful in emergent airway management. Sixty-five patients (47%) had at least one subsequent airway management episode, of which 35 patients (56%) underwent a change of management following alert creation. We proceeded to modify 103 alerts (73%) to improve their quality to aid future encounters.</p><p><strong>Conclusion: </strong>Difficult Airway encounters are an uncommon event in anesthesia, but clear, comprehensive and effectively communicated documentation is required to minimize the risk in future encounters. In our institution, while most difficult airway alerts were appropriate, we found significant heterogeneity in the quality of this documentation, which limits the clinical utility of the alert system. We have taken measures to improve local processes of difficult airway documentation and considered the implications of our project for the broader airway management community.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of combined pudendal nerve and spermatic cord block or caudal epidural block on postoperative analgesia after posterior urethroplasty: a randomized trial.","authors":"Ying Zhou, Wen-Yi Gong, Jing-Yu Zhang, Chen-Guang Li, Bing Xu, Da-Qian Zhang, Kun Fan","doi":"10.1186/s12871-024-02744-x","DOIUrl":"10.1186/s12871-024-02744-x","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB).</p><p><strong>Methods: </strong>Sixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively.</p><p><strong>Results: </strong>Two patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB.</p><p><strong>Conclusions: </strong>PN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB.</p><p><strong>Trial registration: </strong>This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of arm position compared to tourniquet and general anesthesia on peripheral vein width in supine adult patients: a prospective, monocentric, cross-sectional study.","authors":"Christian Berger, Philipp Brandhorst, Elena Asen, Sven Grallert, Sascha Treskatsch, Moritz Weigeldt","doi":"10.1186/s12871-024-02765-6","DOIUrl":"10.1186/s12871-024-02765-6","url":null,"abstract":"<p><strong>Background: </strong>IV access is a commonly performed procedure that is often taught based on tradition rather than evidence. The effect of arm retroflexion on vein width, either alone or in combination with a tourniquet or general anesthesia (GA), remains unclear. In this case, the sonographically measured vein width is a surrogate parameter for the success of the puncture.</p><p><strong>Methods: </strong>Prospective, cross-sectional study involving 57 patients scheduled for surgery in general anesthesia. We analyzed the impact of arm retroflexion, tourniquet, general anesthesia, and their combinations on the antebrachial veins in supine patients by ultrasound. Measurements were taken awake and during general anesthesia, each with and without the application of a tourniquet, and in three different arm positions (0°, 30°, and max° retroflexion) each. Data are presented as median and interquartile range [IQR].</p><p><strong>Results: </strong>Tourniquet application (AT) had the greatest single effect on Cubital vein outer diameter compared to the baseline value of all measures (3.9 mm [3.4-5.1]; 4.8 mm [4.1-5.7], P = 0.001, r = 0.515). This effect was surpassed by the combination of AT and GA (5.1 mm [4.6-6.6], P = 0.001, r = 0.889). In contrast, retroflexion alone did not result in an increase at either 30° (4.2 mm [3.7-5.1], p = 1.0, r = 0.12) or max° (4.2 mm [3.6-4.9], p = 0.72, r = 0.23). With GA and AT, no further enlargement was measurable by 30° (5.4 mm [4.6-6.6], p = 1.0, r = 0.15) or max° (5.4 mm [4.6-6.6], p = 1.0, r = 0.07) retroflexion compared to GA-AT-0° (5.1 mm [4.6-6.6], p = 1.0, r = 0.15).</p><p><strong>Conclusions: </strong>This study provides evidence that retroflexion of the arm in supine patients, whether alone or in addition to a tourniquet or general anesthesia, does not have any additional effect on vein width as a surrogate parameter for successful IV success. It shows for the first time that general anesthesia effectively increases vein diameter.</p><p><strong>Trial registration: </strong>DRKS00029603 (date of registration 07.07.2022).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of epidural ropivacaine versus levobupivacaine for labor analgesia on maternal and fetal outcomes: a meta-analysis.","authors":"Zhen Li, Xinxing Zhou, Hailin Wang","doi":"10.1186/s12871-024-02767-4","DOIUrl":"10.1186/s12871-024-02767-4","url":null,"abstract":"<p><strong>Introduction: </strong>Newer neuraxial local anesthetic agents which have been used as epidural analgesia have shown to provide reliable pain relief during labor. Ropivacaine and levobupivacaine are newer agents now used for labor analgesia. However, even though few studies have made their comparison with bupivacaine, ropivacaine and levobupivacaine have seldom systematically been compared. Therefore, in this analysis, we aimed to systematically show the impact of epidural ropivacaine versus levobupivacaine for labor analgesia on maternal and fetal outcomes.</p><p><strong>Methods: </strong>http://www.</p><p><strong>Clinicaltrials: </strong>gov , Web of Science, MEDLINE, EMBASE, Cochrane database and Google Scholar were searched for studies comparing ropivacaine versus levobupivacaine for labor analgesia. Maternal and fetal outcomes were considered as the endpoints in this analysis. The RevMan software 5.4 was used to analyze data in this study. Risk ratio (RR) with 95% confidence intervals (CI) were used to represent the data post analysis.</p><p><strong>Results: </strong>A total number of 2062 participants were included in this analysis whereby 1054 participants were assigned to ropivacaine and 1008 participants were assigned to levobupivacaine. The main results of this analysis showed that epidural ropivacaine was not associated with significantly higher risk of hypotension (RR: 0.71, 95% CI: 0.43 - 1.17; P = 0.18) and pruritus (RR: 1.12, 95% CI: 0.89 - 1.42; P = 0.34) when compared to levobupivacaine for labor analgesia. However, the risk of nausea and vomiting was significantly higher with ropivacaine (RR: 1.60, 95% CI: 1.05 - 2.44; P = 0.03). Spontaneous vaginal delivery (RR: 0.99, 95% CI: 0.89 - 1.42; P = 0.83), instrumental vaginal delivery (RR: 1.13, 95% CI: 0.89 - 1.45; P = 0.32) and the risk for cesarean section (RR: 0.76, 95% CI: 0.42 - 1.37; P = 0.35) were not significantly different. When fetal outcomes were assessed, Apgar score < 7 at 1 min (RR: 1.01: 95% CI: 0.57 - 1.80; P = 0.97), abnormality of fetal heart rate (RR: 1.45, 95% CI: 0.55 - 3.79; P = 0.45) and neonatal asphyxia (RR: 0.35, 95% CI: 0.10 - 1.18; P = 0.09) were also similarly manifested.</p><p><strong>Conclusions: </strong>To conclude, our analysis showed both epidural ropivacaine and levobupivacaine to be equally effective for labor analgesia in terms of maternal and fetal outcomes. No major adverse maternal and fetal outcome was observed in this analysis. However, considering the several limitations of this analysis, further larger studies should be able to solve and clarify this issue.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensory assessment of intramuscular quadratus lumborum block at the L2 level in open inguinal hernia repair patients.","authors":"Sainan Zhang, Jiaying Sun, Chufan Liu, Xinlian Gong, Ruoxing Chen, Zhousheng Jin, Fangfang Xia, Le Liu, Quanguang Wang, Hongfei Chen","doi":"10.1186/s12871-024-02763-8","DOIUrl":"10.1186/s12871-024-02763-8","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of the quadratus lumborum block (QLB) for postoperative pain management depends on the injection pathway used. There is limited research on the block area produced by intramuscular injection of local anesthesia in the quadratus lumborum muscle. This study aimed to determine the cutaneous sensory blockade area produced by an intramuscular quadratus lumborum block (QLBi) at the L2 level.</p><p><strong>Methods: </strong>Twenty patients aged 18-60 years with ASA grade I-II and a BMI of 18-30 kg/m² who were scheduled for open inguinal hernia repair with mesh underwent ultrasound-guided QLBi injection of 20 ml of 0.5% ropivacaine. The cutaneous sensory blockade area was measured by applying a cold stimulus 1 h after the block and then measured every hour after surgery until the sensation returned to normal. The duration of a blockade is defined as the time it takes for all affected areas to fully regain normal sensation following a blockade. Pain scores (numeric rating scale, NRS) were recorded at 2, 4, 8, 12, and 24 h after surgery. Adverse reactions to QLBi were recorded 24 h after surgery.</p><p><strong>Results: </strong>All 20 patients had reduced or lost cold sensation areas. The greatest extent of cold sensation reduction occurred at T7 (10%), and the least amount of cold sensation reduction occurred at L3 (10%). The block level covered T8 (20%), T9 (30%), T10 (45%), T11 (90%), T12 (95%), L1 (100%), and L2 (15%). Eighteen patients experienced areas of sensory loss, with the highest range at T11 and the lowest at L2. The duration of the blockade was 8.9 ± 3.8 h, with a maximum of 24 h and a minimum of 5 h. One patient experienced quadriceps weakness after surgery.</p><p><strong>Conclusion: </strong>Quadratus lumborum block of intramuscular pathway can produce effective cutaneous sensory blockade, which can be used for postoperative analgesia of indirect inguinal hernia operation, and may also be beneficial to analgesia of other lower abdominal operations. However, the best method needs further confirmation to determine specific anesthesia methods for various operations.</p><p><strong>Chinese clinical trial registry: </strong>June 2, 2018; ChiCTR1800016457.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Startle sign events induced by mechanical manipulation during surgery for neuroma localization: a retrospective cohort study.","authors":"Jonathan M Gorky, Sarah J Karinja, Sylvia L Ranjeva, Lingshan Liu, Matthew R Smith, Ariel L Mueller, Timothy T Houle, Kyle R Eberlin, Katarina J Ruscic","doi":"10.1186/s12871-024-02758-5","DOIUrl":"10.1186/s12871-024-02758-5","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain from peripheral neuromas is difficult to manage and often requires surgical excision, though intraoperative identification of neuromas can be challenging due to anatomical ambiguity. Mechanical manipulation of the neuroma during surgery can elicit a characteristic \"startle sign\", which can help guide surgical management. However, it is unknown how anesthetic management affects detection of the startle sign.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 73 neuroma excision surgeries performed recently at Massachusetts General Hospital. Physiological changes in the anesthetic record were analyzed to identify associations with a startle sign event. Anesthesia type and doses of pharmacological agents were analyzed between startle sign and no-startle sign groups.</p><p><strong>Results: </strong>Of the 64 neuroma resection surgeries included, 13 had a startle sign. Combined intravenous and inhalation anesthesia (CIVIA) was more frequently used in the startle sign group vs. no-startle sign group (54% vs. 8%), while regional blockade with monitored anesthetic care was not associated with the startle sign group (12% vs. 0%), p = 0.001 for anesthesia type. Other factors, such as neuromuscular blocking agents, ketamine infusion, remifentanil infusion, and intravenous morphine equivalents showed no differences between groups.</p><p><strong>Conclusions: </strong>Here, we identified hypothesis-generating descriptive differences in anesthetic management associated with the detection of the neuroma startle sign during neuroma excision surgery, suggesting ways to deliver anesthesia facilitating detection of this phenomenon. Prospective trials are needed to further validate the hypotheses generated.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right-to-left-shunts in patients scheduled for neurosurgical intervention in semi-sitting position - a literature review based on two case scenarios.","authors":"Marina Nikolic, C Eisner, J O Neumann, D Haux, S M Krieg, M O Wielpütz, M A Weigand, U Tochtermann, Dania Fischer","doi":"10.1186/s12871-024-02757-6","DOIUrl":"10.1186/s12871-024-02757-6","url":null,"abstract":"<p><strong>Background: </strong>Neurosurgery performed in the semi-sitting position provides advantages for certain procedures. However, this approach is associated with potential complications, particularly venous air embolism. Due to typically negative venous pressure at the wound site, air can be drawn into the veins. This risk is especially high in patients presenting with an intra- or extracardiac right-to-left-shunt. Transoesophageal echocardiography can be used to detect a patent foramen ovale or other possible pulmonary-systemic shunt before placing the patient in the sitting position.</p><p><strong>Case presentation: </strong>In this report, we present two young patients undergoing scheduled microsurgical vestibular schwannoma removal in a semi-sitting position who were diagnosed with congenital heart defects during routine perioperative assessment to detect possible intracardiac right-to-left shunts, using pre- and intraoperative transesophageal echocardiography (TEE) and additionally conducting an agitated saline bubble study under Valsalva manoeuvre. Patient A was diagnosed with a persistent left superior vena cava and Patient B with an unroofed coronary sinus (UCS). These findings confronted the anesthesiological and surgical teams with difficult individual decisions regarding further perioperative management.</p><p><strong>Conclusions: </strong>Perioperative transesophageal echocardiography is a diagnostic tool to both detect intraoperative position-related air embolisms and to rule out intracardiac right-to-left shunts, e.g. a patent foramen ovale, in order to decide for or against a (semi-)sitting position. Depending on the surgical circumstances a semi-sitting positioning of patients presenting with an intracardiac right-to-left-shunt, e.g. a PFO, can be feasible in individual cases if there is an implemented therapeutic algorithm to immediately terminate significant venous air entry. However, since certain other intra- or extracardiac right-to-left-shunts, such as here presented PLSVC or UCS, are rare, there is no definitive way of estimating the amount of entered air through detected shunts or anomalous vessels. Therefore, it is recommended to avoid a (semi-)sitting position in favour of a lateral or prone position for a patient undergoing intracranial surgery, once the perioperative TEE shows air bubbles in the left atrium or ventricle whose origins cannot be defined solely through TEE for certain in order to ensure patient safety by minimizing the risk of intraoperative paradoxical air embolisms.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroencephalographic depression after abruptly increasing partial pressure of end-tidal carbon dioxide: a case series.","authors":"Shikuo Li, Yuyi Zhao, Qifeng Wang, Xuehan Li, Chao Chen, Yunxia Zuo","doi":"10.1186/s12871-024-02764-7","DOIUrl":"10.1186/s12871-024-02764-7","url":null,"abstract":"<p><strong>Background: </strong>Prolonged electroencephalographic depression during surgery is associated with poor outcomes for patients. However, the published literature on electroencephalographic depression caused by a sudden increase in the partial pressure of end-tidal carbon dioxide (P_ETCO₂) is lacking.</p><p><strong>Case presentation: </strong>We report four patients who were scheduled for laparoscopic liver surgery under general anesthesia. During the process of EEG monitoring with Sedline, four patients experienced electroencephalographic depression closely after a sudden increase in P_ETCO₂. The four patients showed that electroencephalographic depression mainly manifested as a slow in EEG frequency, a reduction in the amplitude and power of EEG, and a decrease in spectral edge frequency. Patient state index was elevated in three cases.</p><p><strong>Conclusions: </strong>To summarize, our patients showed EEG depression when P_ETCO₂ suddenly increased, which suggests that clinical doctors should be alert to electroencephalographic depression when the P_ETCO₂ abruptly increases. EEG monitoring devices should be applied in patients with possible hypercapnia. Anesthesiologists must comprehensively interpret the raw EEG, spectral edge frequency, and density spectral array data, in addition to patient sedation index values.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11476937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of ultrasound-guided erector spinae plane block versus wound infiltration for postoperative analgesia in instrumented lumbar spinal surgeries.","authors":"Yucel Yuce, Secil Azime Karakus, Tahsin Simsek, Ceren Onal, Ozlem Sezen, Banu Cevik, Evren Aydogmus","doi":"10.1186/s12871-024-02754-9","DOIUrl":"10.1186/s12871-024-02754-9","url":null,"abstract":"<p><strong>Objective: </strong>This study compared the efficacy of ultrasound-guided erector spinae plane block (ESPB) and wound infiltration (WI) for postoperative analgesia in patients who underwent lumbar spinal surgery with instrumentation.</p><p><strong>Methods: </strong>In this randomized controlled trial, 80 patients were divided into two groups: ESPB (n = 40) and WI (n = 40). Postoperative pain intensity was assessed via the visual analog scale (VAS) at multiple time points within 24 h. Additionally, opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and patient satisfaction were evaluated.</p><p><strong>Results: </strong>Both ESPB and WI provided effective postoperative pain management, with no significant differences in VAS scores. However, the ESPB group demonstrated a significantly longer duration of analgesia, a shorter time to first rescue analgesia, and lower total tramadol consumption (50 ± 60 mg vs. 100 ± 75 mg; p = 0.010) than did the WI group. Furthermore, a trend toward reduced PONV incidence was observed in the ESPB group, likely due to its opioid-sparing effect.</p><p><strong>Conclusion: </strong>While both ESPB and WI provided effective postoperative pain management, ESPB demonstrated a distinct advantage by offering a longer duration of analgesia and significantly reducing opioid consumption. These findings suggest that ESPB is more effective than WI for postoperative analgesia in lumbar spinal surgeries, providing prolonged pain relief and improving patient outcomes. Further studies are warranted to explore its long-term benefits and cost-effectiveness.</p><p><strong>Trial registration: </strong>ClinicalTrials.govPRS: NCT06567964 Date: 08/21/2024 Retrospectively registered.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11476798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}